- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $3,890.45 / $7,079.46
| Facility | | $177.83 | $3,890.45 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $891.25 / $1,202.26 / $3,890.45
| Facility | 50 | $891.25 | $1,202.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $87.10 / $263.03
| Professional | | $48.98 | $87.10 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $32.36 / $302.00 / $436.52
| Professional | 50 | $32.36 | $302.00 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $102.33 / $154.88
| Professional | | $60.26 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $93.33 / $151.36 / $229.09
| Professional | 50 | $93.33 | $151.36 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $134.90 / $234.42
| Professional | | $74.13 | $134.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $154.88 / $676.08
| Professional | | $89.13 | $154.88 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $100.00 / $218.78
| Professional | | $48.98 | $100.00 | $218.78 |